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deleted993114
"I believe in a multidisciplinary approach to pain". Have you ever read the bio or PR statement of any pain docs on their web sites? Whether academic or private practice, injections only, meds only, ect………………………………. they all say "I believe in a multi-disciplinary approach to pain". However, MOST don't practice it (but apparently just believe it) due to lack of such available resources, financial reasons, ….whatever. It almost seems like a trite, dishonest statement, that is never fully realized.
1. I DONT believe in a multi-disciplinary approach to pain. The most effective goal/treatment is core exercises, increased patient activity, and slight modification of lifting activities. EVERYTHING else that is done (injections, procedures, surgery) is just a gateway to improve pain control such that the above three goals can be met. It does not take an army of providers to instill these notions in patients, nor to orchestrate the implementation of the above. In many instances, a patient does not need an injection/procedure, surgery, psych eval, or advanced diagnostic imaging.
2. A "multi-disciplinary" approach is somewhat akin to the image of captive of native Americans who is compelled to pass through a gauntlet of parallel lines of warriors with clubs, each eager to take a whack at the prisoner. When patients are seen by multiple providers, those providers usually are compelled to do SOMETHING (even if that something may be marginally indicated) and take their "whack" at the prisoner (I mean patient). Thus, over utilization occurs when seeing other specialists is probably only indicated if there is something very specific to address.
3. Everybody in a "multi-disciplinary" approach ends up getting advanced imaging, whether they need it, or not. Not everybody with benign back pain needs an MRI.
4. Patients with acute herniated discs or subacute neurogenic claudication don't need to see a shrink. While everyone is aware that 85% plus of our patients have anxiety and depression (which may be a major factor in their pain), MANY patients sent to pain clinics are those who have more episodic acute periods of pain, rather than continually, long term pain. Such patients usually do not require the evaluation and treatment of a psychologist or psychiatrist like our chronic patients.
5. Having multiple providers of several different disciplines is expensive. We are in a state of affairs in which costs need to be addressed and reduced. Rather than a "cookie cutter", one size fits all approach, having other selected providers (when indicated) see the patient is a more rational, selective approach.
I am still searching, but I think it would be refreshing to find a bio/personal statement by a doc on a website with their smiling face and their arms folded (don't you hate that pose? When the hell did people start doing that? I tell my daughter, who is an M4, to strike her sorority girl pose, rather than the folded arm bit, when she is in practice) saying, "I think the multidisciplinary approach to pain has its merits in chronic. long term pain, it is otherwise bullcrap". I don't think I will find that anytime soon.
1. I DONT believe in a multi-disciplinary approach to pain. The most effective goal/treatment is core exercises, increased patient activity, and slight modification of lifting activities. EVERYTHING else that is done (injections, procedures, surgery) is just a gateway to improve pain control such that the above three goals can be met. It does not take an army of providers to instill these notions in patients, nor to orchestrate the implementation of the above. In many instances, a patient does not need an injection/procedure, surgery, psych eval, or advanced diagnostic imaging.
2. A "multi-disciplinary" approach is somewhat akin to the image of captive of native Americans who is compelled to pass through a gauntlet of parallel lines of warriors with clubs, each eager to take a whack at the prisoner. When patients are seen by multiple providers, those providers usually are compelled to do SOMETHING (even if that something may be marginally indicated) and take their "whack" at the prisoner (I mean patient). Thus, over utilization occurs when seeing other specialists is probably only indicated if there is something very specific to address.
3. Everybody in a "multi-disciplinary" approach ends up getting advanced imaging, whether they need it, or not. Not everybody with benign back pain needs an MRI.
4. Patients with acute herniated discs or subacute neurogenic claudication don't need to see a shrink. While everyone is aware that 85% plus of our patients have anxiety and depression (which may be a major factor in their pain), MANY patients sent to pain clinics are those who have more episodic acute periods of pain, rather than continually, long term pain. Such patients usually do not require the evaluation and treatment of a psychologist or psychiatrist like our chronic patients.
5. Having multiple providers of several different disciplines is expensive. We are in a state of affairs in which costs need to be addressed and reduced. Rather than a "cookie cutter", one size fits all approach, having other selected providers (when indicated) see the patient is a more rational, selective approach.
I am still searching, but I think it would be refreshing to find a bio/personal statement by a doc on a website with their smiling face and their arms folded (don't you hate that pose? When the hell did people start doing that? I tell my daughter, who is an M4, to strike her sorority girl pose, rather than the folded arm bit, when she is in practice) saying, "I think the multidisciplinary approach to pain has its merits in chronic. long term pain, it is otherwise bullcrap". I don't think I will find that anytime soon.
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